(22) New OTP Patient Retention Was Unchanged by COVID Take Home Methadone Increases

Background:
Methadone treatment (MT) is an established treatment for opioid use disorder, with longer treatment duration associated with decreased mortality and improved overall outcomes. Several changes to MT were instituted following Covid-19, the most significant of which was increased take home methadone doses (THM). Yet, increased THM’s impact on MT retention has not been tested.

We assessed whether 3-month retention rates for individuals entering MT following the onset of Covid-19 differed from those who entered one year prior. Additionally, we considered several demographic variables in the group comparisons to determine whether race, sex or age predicted treatment drop out.

Methods:
De-identified chart extractions were obtained from Methasoft electronic dosing records. Data included methadone dosing, treatment intake dates and patient demographics (sex, age and race). Patients were classified into pre-Covid (intake date from from 03/16/2019 -12/16/2019) or post post-Covid (03/16/2020 2020-2/16/2021) groups. We defined MT retention as at least one clinic visit for observed dosing within a two-week period. A discrete-time model was employed to assess the impact of group (pre-vs. post-Covid intake), sex, age and race on treatment drop-out.

Results:
Three months post MT intake, the pre-Covid group had an average of one THM dose/ week; the post-Covid group averaged four THM doses/week. Nonetheless, there were no differences in retention for the pre-and post-Covid groups (OR=.988), with ~65% retention in both groups. Sex was a moderator (OR=2.30, p<.05): there was increased odds of dropout for males in Covid, yet decreased odds for females. Older patients (OR=.963, p<.001) and non-white patients (OR=1.62, p<.01) were more likely to remain in treatment.

Discussion:
To our knowledge, no other studies have used computerized dosing data to evaluate treatment retention and THM status comparing pre- and post-COVID outcomes. Potential unmeasured confounders included type and quantity of drug use, other measures of clinical stability of enrolled patients, and the myriad social effects of life during a pandemic.

The lack of differences in overall retention between the pre-Covid and post-Covid groups—despite an increase in THM doses—suggests clinicians and policymakers should consider continuing alleviated restrictions on THM dispensing, while balancing potential individual and community harms of possible worsened treatment adherence.

Conclusion:
Prior research has also pointed to lower attendance requirements supporting MT retention. Further research is needed to examine the effects of extended THM on other treatment outcomes.

References: 1. Substance Abuse and Mental Health Services Administration (SAMHSA). Opioid Treatment Program (OTP) guidance. Retrieved from https://www.samhsa.gov/sites/default/files/otp-guidance-20200316.pdf
2. H M Rhoades et al. “Retention, HIV risk, and illicit drug use during treatment: methadone dose and visit frequency.”, American Journal of Public Health 88, no. 1 (January 1, 1998): pp. 34-39.
3. Pani, P. P., Pirastu, R., Ricci, A., & Gessa, G. L. (1996). Prohibition of take-home dosages: Negative consequences on methadone maintenance treatment. Drug and Alcohol Dependence, 41(1), 81–84. https://doi.org/10.1016/0376-8716(96)01240-9